Clinton Health Panel Weighed Extreme Views

President Clinton’s ill-fated health reform agenda, which enraged his critics with its complex and massive federal regulatory role, was but a pale version of what his advisers once envisioned, according to internal White House documents released Wednesday.

The working papers of the White House Task Force on National Health Care Reform, which the White House fought to keep secret, showed that the group and its assorted sub-panels considered such measures as a “user fee” on cigarettes of $3 a pack, abolition of the Veterans Administration medical system and a reduction--rather than a freeze--on all medical fees.

Among those that would have been affected by the price controls were not only hospitals and doctors but also blood banks, “health resorts” and even “curative baths or spas operated separately from hospitals.”

The papers, contained in more than 240 boxes delivered to the National Archives, also included the collective opinion of independent accountants that the President’s advisers were overestimating the savings but downplaying the costs of their proposals.

Public aversion to a vast expansion of the government’s role in a restructured health care system as well as the new spending that would be required by Clinton’s plan to provide universal coverage were among the chief reasons that the President’s agenda has been largely discarded by Congress.

It is highly questionable whether any reform legislation, however modest and incremental, can be enacted in the remaining weeks of the current Congress.

The internal documents were released by the White House Wednesday as part of the pretrial proceedings of a federal lawsuit filed here against the Clinton Administration by a group of conservative physicians alleging that the task force went about its work inappropriately by meeting behind closed doors.

A trial is now set for later this year. The documents “confirm what we suspected--that special interest groups were involved in writing the plan,” said Dr. Jane Orient, executive director of the American Assn. of Physicians and Surgeons, which sued the Administration.

The task force relied heavily on advice from “academics, foundations and managed care organizations interested in reducing access to care through rationing,” Orient said.

But White House Deputy Chief of Staff Harold M. Ickes disputed that characterization, saying that the 500-plus participants included “doctors, nurses, academics, business people and federal, state and local officials.”

He added: “In all, this was an unusually accessible process to discuss options for a major presidential policy proposal.”

Ickes also noted the documents “make clear that numerous ideas and proposals for health reform were discussed, analyzed and challenged.”

The papers also revealed that the task force considered but ultimately abandoned before presenting recommendations to the President:

* Malpractice reforms that were being sought by physicians, which would limit to $250,000 the amount of damages for pain and suffering that a victim of malpractice could receive.

* Restricting public access to technological innovations because “unlimited” access was “unrealistic and unaffordable.”

* Abolishing the VA system because it is “too costly and too inefficient.”

Containing costs was a recurring theme through much of the period that the task force was engaged in its frenetic deliberations in the late winter and early spring of 1993.

For instance, during one crucial juncture in the policy development process, a paper was written with the heading: “An Option to Freeze and Control Provider Prices.”

It proposed a sweeping price freeze, followed three to nine months later by “a system that is flexible and enforceable.” In another stage, price growth would be allowed, perhaps pegged to the rate of inflation. The paper also predicted a 50% increase in business volume by doctors as a way to compensate for diminished income.

Separately, the task force considered extending government regulation to all fees charged by doctors and hospitals.

Currently, the federal government only sets rates under Medicare, the program for persons over 65 and the disabled, and under Medicaid, the federal-state health program for the poor. But rates vary considerably for the majority of Americans with private health insurance.

Another potential approach to restrain spending was a temporary surtax on doctors, dentists, hospitals, nursing homes and medical laboratories. Any health provider with revenues greater than the previous year would pay a special tax, ranging from 2% to 30%, on the revenue increase.

The tax would encourage doctors to take more days off. “By causing physicians to take more leisure, they may lead physicians to cut back either patient loads or the intensity of services,” according to one White House paper.

Among the documents available for examination Wednesday was a three-inch-thick briefing book prepared for the President, the final product of untold thousands of hours of meetings.

It had 31 tabular sections with subjects ranging from academic health centers to workers compensation. But missing were any papers on two of the most important topics: financing and insurance reforms.

There was no explanation for the missing sections.